Abstract
Cardiometabolic risk factors are frequent in children and adolescents with excess weight. The aim of this study was to evaluate the effects of lifestyle modifications on alterations in lipid and glycemic profiles and uric acid values in a pediatric population at increased cardiovascular risk. The study involved 276 subjects with a mean age of 10.6 (2.3) years. Body mass index (BMI) z-score and biochemical parameters (serum low-density lipoprotein (LDL) cholesterol, triglycerides and uric acid and homeostasis model assessment to quantify insulin resistance (HOMA index)) were assessed at baseline and at the end of a median follow-up of 14.7 (12.4, 19.3) months. Throughout follow-up, all children received a non-pharmacological treatment based on increased physical activity, reduced sedentary activity and administration of a personalized, healthy and balanced diet. All children attended periodic quarterly control visits during follow-up. Multivariable statistical analyses showed that each BMI z-score point reduction at follow-up was associated with an 8.9 (95% CI −14.2; −3.6) mg/dL decrease in LDL cholesterol (p = 0.001), 20.4 (95% CI −30.0; −10.7) mg/dL in triglycerides (p < 0.001), 1.6 (95% CI −2.2; −1.0) in HOMA index (p < 0.001), and 0.42 (95% CI −0.66; −0.18) mg/dL in uric acid (p = 0.001) values. At each reduction of the BMI z-score by one point, the odds of presenting with insulin resistance and hyperuricemia at follow-up significantly decreased (OR 0.23, 95% CI 0.10–0.50, and OR 0.32, 95% CI 0.10–0.95, p < 0.001 and p < 0.05, respectively). Improvement of dietary habits and lifestyles may improve lipid and glycemic profiles and serum uric acid values in a pediatric population.
Highlights
Healthy lifestyles and diets are recommended for everyone and at all ages, to maintain good health and prevent non-communicable diseases
The aim of this study is to evaluate the effects of dietary-behavioral treatment on alterations in lipid and glycemic profiles and uric acid values in a population of children and adolescents referred to a second-level outpatient clinic for cardiovascular risk assessment in pediatric age
The percentage of children with HOMA index > 90th percentile at the end of follow-up was significantly lower than that at baseline (56.9% vs. 45.3%, p = 0.002), whereas we did not observe any significant change in the number of subjects with dyslipidemia and in those with uric acid values > 90th percentile
Summary
Healthy lifestyles and diets are recommended for everyone and at all ages, to maintain good health and prevent non-communicable diseases. In the presence of cardiovascular risk factors, all guidelines propose a dietary-behavioral intervention as a first step [1–4] This approach is especially recommended for children and adolescents, populations in which medication is used only in very select cases [5–7]. Cardio-metabolic risk factors, such alterations in lipid and glycemic profile and hyperuricemia, are frequently present in children and adolescents that are overweight or obese. In the scientific literature, the information on the effectiveness of dietary-behavioral intervention administered as a therapy in children and adolescents with excess weight to correct altered metabolic profiles is still scarce and fragmentary. The aim of this study is to evaluate the effects of dietary-behavioral treatment on alterations in lipid and glycemic profiles and uric acid values in a population of children and adolescents referred to a second-level outpatient clinic for cardiovascular risk assessment in pediatric age
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